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PubMed1999

Indeterminate melanocytic proliferations of the conjunctiva.

OBJECTIVE: To test the hypothesis that a subset of conjunctival melanocytic proliferations exists that cannot be reproducibly classified as benign, malignant, or indeterminate. METHODS: Three groups of excisional biopsy specimens of conjunctival melanocytic proliferations were evaluated by a panel of 5 ophthalmic pathologists. These groups included lesions that we considered to represent benign (group 1 [n = 5]), malignant (group 2 [n = 5]), and indeterminate melanocytic proliferations (group 3 [n = 5]). The panel classified the same sections in all 3 groups in a randomized, masked fashion, first without and then with a clinical history of patient age, sex, and race. The kappa statistic was used to quantify the degree of agreement among observers. RESULTS: There was strong concordance among the panel members for both group 1 (benign [kappa = 0.76]) and group 2 (malignant [kappa = 0.70]) melanocytic proliferations. There was no concordance of the panel for group 3 (indeterminate) lesions (kappa = -0.045). The concordance for groups 1 and 2 and lack of concordance for group 3 lesions were independent of knowledge of clinical history of age, sex, and race. CONCLUSION: A subset of melanocytic proliferations of the conjunctiva exists that cannot be reproducibly classified by pathologists as benign, malignant, or indeterminate.

Adult↗
PubMed1980

Spindle cell carcinoma of the conjunctiva.

Spindle cell carcinoma, a variant of squamous cell carcinoma, has long been recognized in numerous tissues (including the skin, the upper respiratory tract, the oral cavity, and the esophagus). Two cases of spindle cell carcinoma of the conjunctiva are reported here. Histopathologic examination of these cases shows the characteristic spindle-shaped cells in continuity with the overlying epithelium. Electron microscopy of one case showed desmosomes and cytoplasmic tonofibril-like material. Our direct experience with one of these two cases has shown the malignant neoplasm to be aggressive.

Adult↗
PubMed1983

Nitrous oxide cryotherapy for intraepithelial epithelioma of the conjunctiva.

Nine patients were treated with the nitrous oxide eyelid cryoprobe for large or recurrent intraepithelial epithelioma of the conjunctiva or cornea. Nitrous oxide cryotherapy is more convenient for ocular cryosurgery than liquid nitrogen therapy and seems to be as effective for intraepithelial epithelioma. Surgical debulking of the lesion is recommended before cryosurgery. An obvious advantage of cryosurgery over surgical modalities for intraepithelial epithelioma is that large areas of tumor as well as surrounding tissues can be treated. This procedure results in a higher cure rate and avoids grafting and symblepharon formation. The complications of light cryosurgery seem to be minor even when the cornea is treated. Heavy cryosurgery may result in severe iritis, posterior synechiae, and corneal scarring. A biopsy-proved diagnosis of intraepithelial epithelioma can be misleading and does not rule out the presence of underlying malignant disease.

Aged↗
PubMed1986

Embryonal rhabdomyosarcoma of the conjunctiva. A clinicopathologic and immunohistochemical study.

Rhabdomyosarcoma of the conjunctiva is a rare lesion, with few previously reported cases. We have observed such a tumor occurring in a 16-year-old girl. The clinical and pathologic entities to be considered in differential diagnosis in such cases are several; in this circumstance, immunohistologic reactivity for desmin and myoglobin (two muscle-related proteins) allows a definitive interpretation of rhabdomyosarcoma to be made. This article documents the clinicopathologic features of the epibulbar rhabdomyosarcoma seen in our patient and discusses the immunocytochemical characteristics of myogenic tumors in general, in the context of ocular neoplasia.

Adolescent↗
PubMed1994

Mucosal-associated lymphoid tissue lymphoma of the conjunctiva.

The recognition of mucosal-associated lymphoid tissue as a distinct entity has lead to the separate classification of tumors arising in this tissue, ie, the mucosal-associated lymphoid tissue lymphoma. Five patients with mucosal-associated lymphoid tissue lymphoma of the conjunctiva are described herein; four of the five patients had bilateral tumors. Laboratory analysis was done using microscopy, immunophenotyping, gene rearrangement analysis using both Southern blot and polymerase chain reaction techniques, and oncogene (bcl-1, bcl-2, and c-myc) rearrangement studies. Typical mucosal-associated lymphoid tissue lymphoma features were seen in all patients; three of four patients who underwent testing with immunphenotyping had light-chain restriction, four of five patients had a clone detected using Southern blot analysis, and all five patients showed clones on polymerase chain reaction analysis. No patient demonstrated oncogene rearrangement. In all patients, complete physical examinations and laboratory tests did not detect any evidence of systemic spread. After treatment, no evidence of local recurrence or dissemination was found during follow-up ranging from 2 to 3 years.

Adult↗
PubMed1995

Immunohistochemical localization of epidermal growth factor receptor and epithelial antigen in tumors of the human conjunctiva, eyelid, lacrimal gland, and orbit.

BACKGROUND: Increased numbers of epidermal growth factor (EGF) receptors are observed in squamous cell carcinomas of human lung, head, neck, and cervix. We studied the presence of EGF receptors and epithelial antigen in some ophthalmic lesions. METHODS: Immunohistochemical staining for EGF receptors was assessed in tumors of human conjunctiva, eyelid, lacrimal glands, and orbit with monoclonal antibodies (EGF-R1 and clone 29.1). Reactivity of Ber-EP4, which recognizes epithelial antigen, was also examined. RESULTS: Strong staining of EGF-R1 and clone 29.1 and weak to moderate staining of Ber-EP4 were demonstrated in conjunctival squamous cell carcinomas. Cell membranes of conjunctival papilloma were moderately or strongly stained with these antibodies. Ductal components in sebaceous gland adenoma of the eyelid and pleomorphic adenoma of the lacrimal gland were positively stained. The antibodies did not bind to reactive lymphoid hyperplasia of the orbit and Wegener's granulomatosis. Relatively good correlation for immunostaining reaction was observed among EGF-R1, clone 29.1, and Ber-EP4 in each tumor. CONCLUSION: Immunostaining using EGF-R1, clone 29.1, and Ber-EP4 may be useful in differentiating epithelial tumors from non-epithelial lesions. Strong immunostaining for EGF receptor may be the hallmark of epidermoid malignancy.

Adenoma↗
PubMed1986

Topical application of 5-fluorouracil in premalignant lesions of cornea, conjunctiva and eyelid.

Local application of 5-Fluorouracil was practised on 5 patients. In 3 patients with multiple premalignant oculo-cutaneous lesions, two of whom had also premalignant epibulbar lesions, local 5% 5-Fu cream and/or 1% 5-Fu eyedrops were applied. In 2 other patients who had only premalignant lesions on the cornea and conjunctiva, 1% 5-Fu eyedrops were used only. In animal experiments 1% 5-Fu was not found to cause any damage to normal corneal and conjunctival epithelium. The frequency of the applications and the duration of the treatment were dependent on the location and extent of the lesions. Except for easily treatable lesions, caused by the separation of the tumour epithelium, no complications of local 5-Fu treatment were seen. The visual acuity improved in all 4 patients in whom the cornea was affected. In these premalignant conditions the diagnosis and assessment of the therapy were based on exfoliative cytology and biopsies.

Aged↗
PubMed1996

Malignant melanoma of the conjunctiva: occurrence and survival following surgery and radiotherapy in a Danish population.

PURPOSE: To describe patient characteristics, risk of recurrence, and survival in patients with premalignant and malignant melanocytic lesions of the conjunctiva. METHODS: In a retrospective study, 55 cases with a minimum follow-up of 10 years were reviewed. RESULTS: The actuarial 5-and 10-year survival rates were 86% (95% Cl: 76-96%) and 73% (95% Cl: 60-87%) respectively. The 5-year risk of local recurrence was 35% (95% Cl: 21-49%), and the 10-year risk was 43% (95% Cl: 28-58%). Primary acquired melanosis with atypia was the first manifestation in 13 cases, malignant melanoma in 42 cases. No significant difference in survival and recurrence was found between the two groups or by gender, location of primary lesion, histological characteristics, or extent of surgical procedure. A minimum incidence of 0.052 cases a year per 100 000 in Denmark was calculated. CONCLUSION: The results are estimated to represent a nationwide sample of patients. No prognostic factors of significance were identified.

Adolescent↗
PubMed1986

A prognostic index for patients with malignant melanoma of the conjunctiva.

From 1968 to 1984, 31 patients with histologically proven malignant melanoma of the conjunctiva were treated and followed in the Eye Hospital of the University of München. Histological demonstration of tumor thickness and the mitotic index (number of mitoses per square millimeter) gave a the prognostic index, in which tumor thickness was multiplied by the mitotic index. This index then allowed evaluation of the risk for tumor metastasis. Most tumors measured less than 1.5 mm in thickness, and the metastatic risk was low or medium in these cases. All tumors of the low metastatic risk group had a prognostic index of 1 or less, while all recurrences were associated with a prognostic index that exceeded 1.

Conjunctival Neoplasms↗
PubMed1987

Visible corneal nerve fibers and neuromas of the conjunctiva--a syndrome of type-3 multiple endocrine adenomatosis in two generations.

A case report of multiple mucosal neuroma syndrome (multiple endocrine adenomatosis type 3) is presented in a mother and her two children. In all of them the eye involvement consisted of highly visible corneal nerves, neuromas of the conjunctiva, and thickened eye lids. The mother had mucosal neuromas of the tongue, and in the 4-year-old girl these were seen to appear during the follow-up period. The mother and children had medullary carcinoma of the thyroid. Marfanoid physiognomy was also one characteristic clinical feature.

Adult↗
PubMed2001

Primary lymphoma of the conjunctiva--a rare manifestation of indolent non-Hodgkin's lymphoma.

Lymphoid tumours of the conjunctiva are extremely rare. Such tumours can appear as an isolated neoplasm or as part of a systemic disease. We describe the clinical and histopathologic findings of a patient with bilateral conjunctival lymphoma who presented with a 5-year history of chronic conjunctivitis. After clinical staging, including (1) thoracic and abdominal computerised tomography scans, (2) magnetic resonance tomography of the brain and orbita, (3) fibre-optic gastrointestinoscopy, (4) colonoscopy and (5) bone marrow biopsy,.no other foci of the lymphoma were found. The patient received radiation therapy and achieved complete remission. We conclude that conjunctival lymphoma should be included in the differential diagnoses of chronic conjunctivitis. Persisting signs and symptoms of conjunctivitis not responding to standard treatment should prompt biopsy.

Biopsy↗
PubMed2006

[Squamous cell carcinoma of the conjunctiva with orbital invasion: orbital exenteration or minimally invasive procedure?].

BACKGROUND: Here we present a case of a female patient with squamous cell carcinoma with orbital invasion who insisted on a globe-sparing excisional biopsy rather than a more invasive procedure. CASE: A 48-year-old patient presented with a conjunctival tumor at the medial canthus of the right eye. The visual acuity in this eye was 1.0. MRI showed a 25 mm x 12 mm tumor, with orbital invasion, no metastasis, but on CT scan damage of the lamina papyracea was suspected. Histology of a punch biopsy confirmed a moderately differentiated, squamous cell carcinoma. As requested by the patient, simple tumor excision with a 5-mm safety margin, reconstruction of the lower fornix with amniotic membrane, and adjuvant mitomycin C therapy were performed. Intraoperatively the medial orbital wall was found to be intact. No local or systemic recurrence has occurred 3.5 years postoperatively. The patient's VA is still 1.0; no visual field defects are detectable, and there are only minor upper lid levator restriction and diplopia in maximum upgaze. CONCLUSION: In view of this case the choice of surgical treatment for malignant tumors of the conjunctiva with orbital invasion - between exenteration or a minimally invasive procedure - should be carefully discussed with the patient. A follow-up of 5 years is strongly recommended.

Carcinoma, Squamous Cell↗
PubMed2006

Malignant melanoma of the conjunctiva with intraocular extension: a clinicopathological study of three cases.

BACKGROUND: Malignant melanoma of the conjunctiva is a rare tumour with an unpredictable behaviour, characterised by the high risk of local recurrence and metastatic spread. Intraocular extension of a conjunctival melanoma is rare. We present three cases of primary conjunctival melanoma with intraocular extension. METHODS: Three patients presented with primary conjunctival melanomas, which either arose at or later involved the limbus on a background of primary acquired melanosis. Despite adequate primary local excision and adjuvant chemotherapy, all three patients experienced several recurrences, requiring further surgery. Two of the patients had excision of the tumour that required superficial keratectomy. One of these patients then required two further procedures in which the anterior chamber was breached. RESULTS: All three patients ultimately required enucleation or exenteration to control local disease. All three specimens showed intraocular extension. CONCLUSIONS: The management of conjunctival melanoma can be difficult. In addition to local recurrence and metastases, limbal melanomas may rarely show intraocular extension, particularly if surgery to excise the tumour requires the removal of Bowman's membrane. Regular follow-up of these patients is mandatory.

Aged↗
PubMedDate not supplied

Human herpesvirus-8 in Kaposi's sarcoma of the conjunctiva in a patient with AIDS.

PURPOSE: To demonstrate human herpesvirus-8 (HHV-8) in Kaposi's sarcoma (KS) of the conjunctiva in a patient with acquired immunodeficiency syndrome (AIDS). METHODS: Clinical observation, pathologic findings of conjunctival specimens, immunohistochemical staining for HHV-8-specific antigen, polymerase chain reaction (PCR) analysis of HHV-8 DNA, and detection of specific antibody in patient's serum at appropriate times. RESULTS: In the conjunctival specimen, swollen endothelial-like cells were found with slit-like vessels. CD 31-positive cells were noted on the inner surface of the slit-like vessels, and HHV-8 latency-associated nuclear antigen was detected. The presence of HHV-8 DNA was demonstrated by PCR. Anti-HHV-8 antibody was found in the patient's serum. CONCLUSIONS: This is the first case report in the ophthalmology literature that provides histological, DNA, and serological evidence that HHV-8 is involved in the pathogenesis of conjunctival KS.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Myxomas of the conjunctiva.

Fourteen cases of rare conjunctival myxoma were studied clinicopathologically. The median age of the eight men and six women was 50 years (range, 18 to 76 years). The tumors appeared as slowly growing, freely movable solitary lesions located primarily in the temporal bulbar conjunctiva. The clinical diagnosis was cyst in many cases. The lesions were removed by simple local excision and did not recur. Histologically, they were hypocellular and were composed of stellate and spindle-shaped cells; some had small intracytoplasmic and intranuclear vacuoles. The stroma contained abundant mucoid material and sparse reticulin and delicate collagen fibers. Scattered mast cells were found in many lesions. Ultrastructurally, the intracytoplasmic vacuoles appeared to be extremely dilated cisternae of rough-surfaced endoplasmic reticulum. Invaginations of the nuclear membrane by the cytoplasm correlated with intranuclear vacuoles seen by light microscopy. Conjunctival myxomas are benign tumors and should be differentiated from other benign and malignant soft-tissue tumors with myxomatous features.

Adolescent↗
PubMed1988

Fibrous histiocytoma of the corneoscleral limbus and conjunctiva.

An 11-year-old boy and a 28-year-old woman each had a painless, slowly enlarging, elevated, yellow lesion of the inferior corneoscleral limbus and adjacent cornea and conjunctiva of the left eye. Histopathologic examination of both lesions disclosed involvement of the conjunctival substantia propria and the adjacent limbal and peripheral corneal stroma by a nonencapsulated, dense infiltrate composed of elongated fibrocytic cells, plump histiocytic cells occasionally with a vacuolated cytoplasm, some multinucleated giant cells, and scattered lymphocytes. The diagnosis in each case was fibrous histiocytoma. Both patients were otherwise in good health with no dermatologic, systemic, or other ocular abnormalities.

Adult↗
PubMed1982

The use of preputial skin to replace conjunctiva and to correct ectropion.

The prepuce can provide a large amount of soft delicate skin suitable for replacement of lost conjunctiva or in the surgical treatment of ectropion. Three typical examples of its uses are described: two of ectropion following burns and one case with a carcinoma of the conjunctive which was excised and replaced with a free graft from the inner lining layer of the prepuce.

Adult↗
PubMed1990

Immunohistologic analysis of small lymphocytic infiltrates of the orbit and conjunctiva.

In a prior study we reported that monotypic immunoglobulin expression significantly correlated with an increased risk of dissemination by small lymphocytic infiltrates (SLIs) of the orbit and conjunctiva. However, less than half of all monotypic SLIs disseminated. In this study, we applied a large panel of monoclonal antibodies to cryostat sections of orbital and conjunctival SLIs to address two questions. First, might immunohistologic results other than immunoglobulin staining predict which patients with monotypic SLIs will develop disseminated lymphoma? Second, what is the usefulness of these findings in the diagnosis of orbital and conjunctival SLIs? We found that immunohistologic results did not significantly predict or correlate with disseminated lymphoma in patients with monotypic SLIs, either at time of presentation (ie, staging evaluation positive) and/or subsequently. However, three monotypic infiltrates (10%) had a proliferative rate (Ki-67-positive) of 20% or greater, and all three cases disseminated. Regarding the usefulness of the antibody panel, a B to T cell ratio of 4 or greater (76%), anomalous pan-T cell antigen expression by B cells (38%), and pan-B cell antigen loss (15%) were found exclusively in monotypic SLIs. Combining these results, 80% of monotypic SLIs had additional immunophenotypic criteria of lymphoma. Thus, these findings appear to be useful, although less helpful than immunoglobulin staining, and provide another means of immunophenotypic diagnosis when the results of immunoglobulin staining are technically unsatisfactory or difficult to interpret. We were unable to detect anomalous antigen expression or antigen loss in polytypic infiltrates, including one lesion which locally recurred 30 months later as a histologically indistinguishable, clearly monotypic SLI. We attribute the absence of these findings in polytypic SLIs to their relatively infrequent occurrence in monotypic infiltrates and/or to our inability to detect small clones of malignant cells (if present) by our immunohistologic methods.

Adult↗